Volume 38, Issue 4 pp. 582-588

Original Article

Traction injury of the recurrent laryngeal nerve: Results of continuous intraoperative neuromonitoring in a swine model

Hye Yoon Lee MD, PhD,

Hye Yoon Lee MD, PhD

Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea

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Young Geon Cho MD,

Young Geon Cho MD

Advanced Materials Characterization Laboratory at School of Mechanical Engineering, Korea University, Seoul, Korea

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Ji Young You MD,

Ji Young You MD

Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea

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Byoung Ho Choi MD, PhD,

Byoung Ho Choi MD, PhD

Advanced Materials Characterization Laboratory at School of Mechanical Engineering, Korea University, Seoul, Korea

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Joon Yub Kim MD, PhD,

Joon Yub Kim MD, PhD

Department of Orthopaedic Surgery, Myongji Hospital, Seoul, Korea

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Che-Wei Wu MD, PhD,

Che-Wei Wu MD, PhD

Department of Otolaryngology – Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan

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Feng-Yu Chiang MD, PhD,

Feng-Yu Chiang MD, PhD

Department of Otolaryngology – Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan

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Hoon Yub Kim MD, PhD,

Corresponding Author

Hoon Yub Kim MD, PhD

Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea

Corresponding author: H. Y. Kim, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 136–705, Korea. E-mail: [email protected]Search for more papers by this author

Hye Yoon Lee MD, PhD,

Hye Yoon Lee MD, PhD

Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea

Search for more papers by this author

Young Geon Cho MD,

Young Geon Cho MD

Advanced Materials Characterization Laboratory at School of Mechanical Engineering, Korea University, Seoul, Korea

Search for more papers by this author

Ji Young You MD,

Ji Young You MD

Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea

Search for more papers by this author

Byoung Ho Choi MD, PhD,

Byoung Ho Choi MD, PhD

Advanced Materials Characterization Laboratory at School of Mechanical Engineering, Korea University, Seoul, Korea

Search for more papers by this author

Joon Yub Kim MD, PhD,

Joon Yub Kim MD, PhD

Department of Orthopaedic Surgery, Myongji Hospital, Seoul, Korea

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Che-Wei Wu MD, PhD,

Che-Wei Wu MD, PhD

Department of Otolaryngology – Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan

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Feng-Yu Chiang MD, PhD,

Feng-Yu Chiang MD, PhD

Department of Otolaryngology – Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan

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Hoon Yub Kim MD, PhD,

Corresponding Author

Hoon Yub Kim MD, PhD

Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea

First published: 09 December 2014

https://doi.org/10.1002/hed.23934

Citations: 25

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Abstract

Background

Recurrent laryngeal nerve (RLN) palsy is the most serious complication after thyroidectomy. However, little is known about the degree of traction injury that causes loss of signal. The purpose of this study was to evaluate traction injuries in the swine RLN using continuous intraoperative neuromonitoring (IONM) and determine the traction power that results in loss of signal.

Methods

Thirteen swine underwent traction injury to the RLNs with continuous IONM, and stress-strain curves were determined for 8 nerves using the universal material testing machine in an ex vivo model.

Results

Traction injury at a mean power of 2.83 MPa caused loss of signal. The mean physiologic limit strain and tensile strength of the swine RLNs were found to be 15.0% and 4.9 MPa, respectively. Histological analysis showed no abnormal structural findings.

Conclusion

Traction injury of swine RLNs causes loss of signal at a power of 2.83 MPa. However, all injured nerves recovered within 7 days with no observed structural damage. © 2015 Wiley Periodicals, Inc. Head Neck 38: 582–588, 2016

REFERENCES

1 Smith E, Taylor M, Mendoza M, Barkmeier J, Lemke J, Hoffman H. Spasmodic dysphonia and vocal fold paralysis: outcomes of voice problems on work-related functioning. Journal of voice: official journal of the Voice Foundation 1998; 12(2): 223–32.
10.1016/S0892-1997(98)80042-8
CAS PubMed Web of Science® Google Scholar
2 Dralle H, Sekulla C, Lorenz K, Brauckhoff M, Machens A; German IONM Study Group. Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg 2008; 32: 1358–1366.
10.1007/s00268-008-9483-2
CAS PubMed Web of Science® Google Scholar
3 Randolph GW. Surgical anatomy of the recurrent laryngeal nerve. In: GW Randolph, editor. Surgery of the thyroid and parathyroid glands. Philadelphia, PA: Saunders; 2003. pp 300–342.
Google Scholar
4 Dralle H, Sekulla C, Haerting J, et al. Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery 2004; 136: 1310–1322.
10.1016/j.surg.2004.07.018
PubMed Web of Science® Google Scholar
5 Chiang FY, Wang LF, Huang YF, Lee KW, Kuo WR. Recurrent laryngeal nerve palsy after thyroidectomy with routine identification of the recurrent laryngeal nerve. Surgery 2005; 137: 342–347.
10.1016/j.surg.2004.09.008
PubMed Web of Science® Google Scholar
6 Chiang FY, Lu IC, Kuo WR, Lee KW, Chang NC, Wu CW. The mechanism of recurrent laryngeal nerve injury during thyroid surgery–the application of intraoperative neuromonitoring. Surgery 2008; 143: 743–749.
10.1016/j.surg.2008.02.006
PubMed Web of Science® Google Scholar
7 Snyder SK, Lairmore TC, Hendricks JC, Roberts JW. Elucidating mechanisms of recurrent laryngeal nerve injury during thyroidectomy and parathyroidectomy. J Am Coll Surg 2008; 206: 123–130.
10.1016/j.jamcollsurg.2007.07.017
PubMed Web of Science® Google Scholar
8 Chiang FY, Lee KW, Chen HC, et al. Standardization of intraoperative neuromonitoring of recurrent laryngeal nerve in thyroid operation. World J Surg 2010; 34: 223–229.
10.1007/s00268-009-0316-8
PubMed Web of Science® Google Scholar
9 Dionigi G, Alesina PF, Barczynski M, et al. Recurrent laryngeal nerve injury in video-assisted thyroidectomy: lessons learned from neuromonitoring. Surg Endosc 2012; 26: 2601–2608.
10.1007/s00464-012-2239-y
CAS PubMed Web of Science® Google Scholar
10 Schneider R, Randolph GW, Sekulla C, et al. Continuous intraoperative vagus nerve stimulation for identification of imminent recurrent laryngeal nerve injury. Head Neck 2013; 35: 1591–1598.
10.1002/hed.23187
PubMed Web of Science® Google Scholar
11 Snyder SK, Hendricks JC. Intraoperative neurophysiology testing of the recurrent laryngeal nerve: plaudits and pitfalls. Surgery 2005; 138: 1183–1191; discussion 1191–1192.
10.1016/j.surg.2005.08.027
PubMed Web of Science® Google Scholar
12 Randolph GW, Dralle H, International Intraoperative Monitoring Study Group, et al. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope 2011; 121 Suppl 1: S1–S16.
10.1002/lary.21119
PubMed Web of Science® Google Scholar
13 Wu CW, Dionigi G, Sun H, et al. Intraoperative neuromonitoring for the early detection and prevention of RLN traction injury in thyroid surgery: a porcine model. Surgery 2014; 155(2): 329–39.
10.1016/j.surg.2013.08.015
PubMed Web of Science® Google Scholar
14 Lamade W, Ulmer C, Seimer A, et al. A new system for continuous recurrent laryngeal nerve monitoring. Minim Invasive Ther Allied Technol 2007; 16(3): 149–54.
10.1080/13645700701383241
PubMed Web of Science® Google Scholar
15 Ulmer C, Koch KP, Seimer A, et al. Real-time monitoring of the recurrent laryngeal nerve: an observational clinical trial. Surgery 2008; 143(3): 359–65.
10.1016/j.surg.2007.10.007
PubMed Web of Science® Google Scholar
16 Schneider R, Przybyl J, Hermann M, Hauss J, Jonas S, Leinung S. A new anchor electrode design for continuous neuromonitoring of the recurrent laryngeal nerve by vagal nerve stimulations. Langenbecks Arch Surg 2009; 394(5): 903–10.
10.1007/s00423-009-0503-y
PubMed Web of Science® Google Scholar
17 Haftek J. Stretch injury of peripheral nerve. Acute effects of stretching on rabbit nerve. J Bone Joint Surg Br 1970; 52(2): 354–65.
10.1302/0301-620X.52B2.354
PubMed Google Scholar
18 Schneider R, Bures C, Lorenz K, Dralle H, Freissmuth M, Hermann M. Evolution of Nerve Injury with Unexpected EMG Signal Recovery in Thyroid Surgery Using Continuous Intraoperative Neuromonitoring. World J Surg 2013; 37(2): 364–8.
10.1007/s00268-012-1853-0
PubMed Web of Science® Google Scholar
19 Lo CY, Kwok KF, Yuen PW. A prospective evaluation of recurrent laryngeal nerve paralysis during thyroidectomy. Arch Surg 2000; 135(2): 204–7.
10.1001/archsurg.135.2.204
CAS PubMed Web of Science® Google Scholar
20 Coghill AM, Garson LR, American Chemical Society. The ACS style guide: effective communication of scientific information. 3rd ed. Washington, DC, Oxford; New York: American Chemical Society; Oxford University Press; 2006. xiv, 430 p. p.
Google Scholar

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Volume38, Issue4

April 2016

Pages 582-588

Traction injury of the recurrent laryngeal nerve: Results of continuous intraoperative neuromonitoring in a swine model

Abstract

Background

Methods

Results

Conclusion

REFERENCES

Citing Literature

References

Information

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Traction injury of the recurrent laryngeal nerve: Results of continuous intraoperative neuromonitoring in a swine model

Abstract

Background

Methods

Results

Conclusion

REFERENCES

Citing Literature

References

Related

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